A 53-year-old woman presented in a referring hospital and received intravenous tenecteplase for anterolateral myocardial infarction (Fig. 1A). Due to lack of improvement, she was transferred for rescue percutaneous coronary intervention. Successful percutaneous coronary intervention was performed on the left anterior descending artery, although persisting slow flow was noted (Figs. 1B and 1C, Online Video 1). Diffuse narrowing of the distal left anterior descending artery was also observed, suggesting external compression of the vessel.

The left ventriculography showed anterolatero-apical akinesis with aneurismal dilation of the left ventricle and an apical thrombus. Surprisingly, extravasation of contrast within the myocardium was visible in the anterior free wall (Fig. 1D, Online Video 2). Impeding left ventricular rupture was suspected. After re-interrogation, the patient mentioned that chest pain had begun 3 weeks before admission and that she had been treated with nonsteroidal anti-inflammatory drugs without improvement. Minutes after transfer to the intensive care unit, she developed electromechanical dissociation and died. Per cardiopulmonary resuscitation, echocardiogram revealed cardiac tamponade.

Appendix

For accompanying videos, please see the online version of this paper.

Footnotes

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.